Eating Disorders in Young Women with Type 1 Diabetes

Abstract

Disordered eating attitudes and behavior are common and persistent in adolescent and young adult females with type 1 diabetes, and are associated with impaired metabolic control and a higher risk of diabetes-related complications. Specific aspects of diabetes and its management, e.g. weight gain associated with initiation of insulin treatment or improved metabolic control, and dietary restraint, may trigger the body dissatisfaction and drive for thinness that accompany eating disturbances. Health care providers should be aware of the possible association between eating disturbances and diabetes, and also of the types of behavior, particularly insulin omission for weight loss, that are common in these young women. Therapy will depend on the severity of the eating disturbance. Group psychoeducation, incorporating a nondeprivational approach to eating, may prove effective, especially in those with milder degrees of eating and weight psychopathology.

Clinical Characteristics and Outcome of 467 Patients With a Clinically Recognized Eating Disorder Identified Among 52,215 Patients With Type 1 Diabetes: A Multicenter German/Austrian Study

“…Severe caloric restriction may lead to higher rates of hypoglycemia (33) and insulin restriction to more frequent episodes of diabetic ketoacidosis (23).…”

Insulin Restriction and Associated Morbidity and Mortality in Women with Type 1 Diabetes

“…Studies documenting the high rate of mortality in eating disorders (22) suggest that diabetic patients with significant eating disorder symptoms and any insulin restriction should be carefully monitored. Factors associated with type 1 diabetes treatment, such as careful attention to food portions and choices, regular exercise, regular blood glucose monitoring, and treatment of hypoglycemia, may contribute to eating and weight concerns in this population (23) and may predispose individuals with diabetes to develop diabetes-specific disordered eating attitudes and behaviors. Indeed, weight gain is a common side effect of intensive insulin treatment (1,24).…”

Diabetes and behavioral medicine: The second decade.

“…Regardless of causal link, treatment with either pharmacotherapy or psychotherapy improves both depressive symptoms and diabetes control (Lustman, Freedland, Griffith, & Clouse, 2000;Lustman, Griffith, Freedland, Kissel, & Clouse, 1998). Another problem of special concern in diabetes management is the presence of eating disorders, which are far more prevalent in adolescent and young adult females with T1DM (Jones, Lawson, Daneman, Olmsted, & Rodin, 2000;Rodin, Johnson, Garfinkel, Daneman, & Kenshole, 1986) than in other groups and are also associated with a greatly increased risk of poor metabolic control, retinopathy, and other health complications (Daneman, Olmsted, Rydall, Maharaj, & Rodin, 1998;Rydall, Rodin, Olmsted, Devenyi, & Daneman, 1997). This increased vulnerability to eating disorders may reflect the degree of attention focused on food intake in diabetes, as well as concerns about weight gain secondary to insulin use.…”